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  • Primary affects lung
  • Mold: Hyphae that branches 45°
  • Inhalation

Clinical Features

Allergic Bronchopulmonary Aspergillosis (ABPA)

  • Hypersensitivity reaction to A fumigatus
  • Asthma and cystic fibrosis
  • Cough, mucous plugs, bronchial casts, hemoptysis, wheezing
  • +/- Allergic fungal sinusitis

Chronic Necrotizing Aspergillosis Pneumonia (CNPA)

Aspergilloma (Fungus ball)

  • Preexisting cavitary lung disease (Tb, sarcoidosis) or cystic lesion (PCP)
  • Hemoptysis, cough and fever
  • Asymptomatic radiographic abnormality

Invasive aspergillosis

  • Neutropenia or immunosuppression
  • Organ transplantation (bone marrow), leukemia, lymphoma, chemotherapy
  • Long-term steroid use (ex COPD)
  • Fever, cough, dyspnea, pleuritic chest pain, hemoptysis
  • Rapidly progressive, can be fatal
  • Can cause skin infection

Differential Diagnosis

Causes of Pneumonia






  • ABPA
    • Eosinophilia
    • Skin test + for A. Fumigatus
    • Serum IgE > 1000 IU/dL or > x 2-fold rise from baseline
    • Aspergillus precipitins +
    • Aspergillus radioallergosorbent assay test + and sputum culture
    • CXR: Fleeting pulmonary infiltrates, mucoid impaction, central bronchiectasis
    • CT chest: Bronchiectasis, lobulated masses that are mucus-filled dilate bronchi
  • Aspergilloma
    • Precipitin Ab test +
    • CXR/CT: Mass in preexisting cavity, often in upper lobe (crescent of air outlining solid mass)
  • Invasive apsergillosis and CNPA
    • Visualization of fungi (Silver stain)
    • Positive culture from sputum, needle biopsy, or BAL
    • Galactomannan level
    • CXR: Nodules, cavitary lesions, alveolar infiltrates
    • CT chest: Halo sign, screscent of air surrounding nodules, wedge-shaped or pleural-based infiltrates, cavitation, pulmonary infarction


  • Pulmonary consult +/- ID consult
  • ABPA: Oral corticosteroids
    • Recurrent chronic, add oral itraconazole +/- surgical resection of nasal polyp
  • Aspergilloma
  • Invasive aspergillosis
    • Voriconazole DOC
    • Alternative: Posaconazole, amphotericin B, caspofungin
    • Reduce immunosuppression
  • CNPA
    • Voriconazole, itraconazole, caspogungin, or amphotericin
    • Reduce immunosuppression

Special Population: Cystic Fibrosis

  • Diagnosis: Clinical deterioration; IgE> 1000IU/mL or > 2-4x baseline; + serology; new infiltrate
  • Treatment: New radiologic finding and symptoms and change in baseline IgE >500 IU/mL


  • Invasive aspergillosis often requires admission
  • Admit if massive hemoptysis
  • ABPA usually managed outpatient

See Also

External Links